Influence of age, previous health status, and severity of acute illness on outcome from intensive care

Gall, J. R. Le; Brun‐Buisson, C.; Trunet, P; Latournerie, J; Chantereau, S; Rapin, M

doi:10.1097/00003246-198209000-00003

Cited by 93 publications

(40 citation statements)

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“…Nonsurvivors had a greater burden of comorbidity and poorer preadmission QOL scores in all subscales. A finding that is matched by previous studies showing a predictive value of comorbidity and functional health status on short-and long-term outcome of ICU patients [3,5,19,29,30]. Subsequent survival of patients discharged from hospital was 91.7 % at 6 months (99 % expected survival in the general population adjusted for sex and age), which is comparable to the mortality rates reported in earlier follow-up studies [6,7,11].…”

Section: Discussionsupporting

confidence: 83%

Changes in quality of life after medical intensive care

Wehler

Martus²,

Geise³

et al. 2000

Intensive Care Med

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Six months after admission to a medical ICU most survivors had regained their preadmission health-related QOL. Multivariate analysis showed that preadmission QOL, age, and severity of illness were most strongly associated with follow-up QOL. Of the survivors 86 % were living at home, and all but one of those previously in employment had returned to their former work. Most patients (94%) would undergo ICU treatment again if necessary.

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Section: Discussionsupporting

confidence: 83%

Changes in quality of life after medical intensive care

Wehler

Martus²,

Geise³

et al. 2000

Intensive Care Med

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“…continuous haemodialysis/haemofiltration, early enteral nutrition). Factors that correspond to the outcome of critically ill patients are the underlying disease [4,[15][16][17][18], the severity of illness [12], the amount of time for patient care [4], and patient age [4,[15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

1997

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Objective: To assess temporal changes in patient characteristics, nursing workload and outcome of the patients and to compare the actual amount of available nursing staff with the estimated needs in a medical-surgical ICU. Design: Retrospective analysis of prospectively collected data. Setting: A medical-surgical adult intensive care unit (ICU) in a Swiss university hospital. Patients: Data of all patients staying in the ICU between January 1980 and December 1995 were included. Interventions: None. Measurements and results:The estimated number of nurses needed was defined according to the Swiss Society of Intensive Care Medicine (SGI) grading system: category I = one nurse/patient/shift ( = 8 h), category II = one nurse/two patients/shift, category III= one nurse/ three patients/shift. An intervention score (IS) was obtained, based on a number of specific activities in the ICU. There was a total of 35,327 patients (32 % medical and 68 % postoperative/trauma patients). Over time, the number of patients per year increased (1980/1995: 1,825/2,305, p < 0.001) and the length of ICU stay (LOS) decreased (4.1/3.8 days, p < 0.013). There was an increase in the number of patients aged > 70 years (19 %/28 %, p < 0.001), and a decrease in the number of patients < 60 years (58 %/41%, p < 0.001). During the same time period, the IS increased two-fold. Measurement of nursing workload showed an increase over time. The number of nursing days per year increased (1980/1995: 7454/8681, p < 0.019), as did the relative amount of patients in category I (49 %/71%,p < 0.001), whereas the portion of patients in category II (41%/28 %, p < 0.019) and category III (10 %/0 %) decreased. During the same time period, mortality at ICU discharge decreased (9.0 %/ 7.0 %, p < 0.002). Conclusions: During the last 16 years, there has been a marked increase in workload at this medicalsurgical ICU. Despite an increase in the number of severely sick patients (as defined by the nursing grading system) and patient age, ICU mortality and LOS declined from 1980 to 1995. This may be ascribed to improved patient treatment or care. Whether an increasingly liberal discharge policy (transfer to newly opened intermediate care units, transfer of patients expected to die to the ward) or a more rigorous triage (denying admission to patients with a very poor prognosis) are confounding factors cannot be answered by this investigation. The present data provide support for the tenet that there is a trend toward more complex therapies in increasingly older patients in tertiary 1166 care ICUs. Calculations for the number or nurses needed in an ICU should take into account the increased turnover of patients and the changing patient characteristics.

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“…The presence of associated complications on admission was recorded according to the following definitions: 1) "respiratory infection" was defined as the presence of fever, purulent sputum and leucocytosis, associated with new and persistent radiographic infiltrates [11]; 2) "sepsis syndrome" was defined as positive blood cultures or fever >39°C, together with positive cultures from suspected sources (urine, abscess, draining wound, ascites or pleural fluid) [12]; 3) "shock" was defined as systolic hypotension lower than 90 mmHg with decreased urinary output, or hypotension requiring vasoactive amines infusion to obtain blood pressure of ≥90 mmHg [13]; 4) "renal failure" was defined as an acute rise in serum creatinine >265.2 µmol·l -1 in patients with previously normal renal function [12]; 5) "cardiac impairment" included arrhythmia requiring emergency therapeutic intervention, or tachycardia along with clinical and radiographic evidence of pulmonary congestion which resolved with diuretic therapy, or a decreased cardiac index with increased wedge pressure [12]; 6) "disseminated intravascular coagulation" was defined as the presence of thrombocytopenia (<80 platelets×10 3 ·mm -3 ), increased prothrombin time, increased fibrinogen degradation products, or decreased fibrinogen levels [12]; 7) "gastrointestinal complications" included macroscopic digestive bleeding, or intestinal perforation or acute intestinal ischaemia demonstrated by laparotomy, or pancreatitis with a twofold increase in amylase or lipase enzymes, or hepatic dysfunction defined as a twofold increase of glutamic pyruvic transaminase or alkaline phosphatase or development of jaundice [12]; 8) "coma" was defined as a Glasgow coma score <10 [14]; 9) "metabolic complications" included hyponatraemia <120 mmol·l -1 , or serum potassium <3.0 mmol·l -1 or >6.0 mmol·l -1 , or hypercalcaemia, or alkalosis with pH >7.60, or metabolic acidosis (pH <7.20). The resultant score was the addition of the number of associated complications (NAC).…”

Section: Methodsmentioning

confidence: 99%

Arterial oxygenation does not predict the outcome of patients with acute respiratory failure needing mechanical ventilation

Jiménez

Torres²,

Roca³

et al. 1994

Eur Respir J

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A Ar rt te er ri ia al l o ox xy yg ge en na at ti io on n d do oe es s n no ot t p pr re ed di ic ct t t th he e o ou ut tc co om me e o of f p pa at ti ie en nt ts s w wi it th h a ac cu ut te e r re es sp pi ir ra at to or ry y f fa ai il lu ur re e Using a discriminant multivariate analysis, the following variables were selected as the best predictors of outcome: 1) the number of associated complications (NAC) on admission; 2) the simplified acute physiologic score (SAPS); 3) oxygenation index (PAO 2 -AaPO 2 )/PAO 2 + 0.014 positive end-expiratory pressure (PEEP); and 4) the age of the patients.Using these predictors, 84% of the patients were accurately classified as survivors or as nonsurvivors. The partial contribution of each predictor to the model was also assessed using a logistic regression, by eliminating each single predictor and each possible pair of predictors. Using this means of analysis, the NAC and SAPS were the only predictors of mortality. The inclusion of short-term mechanicallyventilated patients did not bias the accuracy of prediction.

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Influence of age, previous health status, and severity of acute illness on outcome from intensive care

Cited by 93 publications

References 0 publications

Changes in quality of life after medical intensive care

Changes in quality of life after medical intensive care

Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

Arterial oxygenation does not predict the outcome of patients with acute respiratory failure needing mechanical ventilation

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